- Authorization to Release Patient Information
- Autorización para divulgar información del paciente en español
Instructions: Please complete all portions of this authorization and bring with you to the Health Information Management Department. To expedite the process, you may fax the completed form and a copy of the patient’s valid photo ID to the HIM Department: 970.384.8179.
Please specify if you would like to pick up copies in person or if you would like to have them mailed to you. Requests for medical records are processed in the order in which they are received. Please allow 24-hours for us to process your request.
If you have any questions, please contact: 970.384.6800